Tehran University Medical Journal

Background: Posterolateral rotatory instability is one of the most complex problems in ligamentous injuries of the knee. It represents a challenging diagnostic and therapeutic problem for the orthopaedic surgeon. We present the results of biceps tenodesis in chronic posterolateral rotatory instabilily of the knee.

Methods: In this case series we included all of the patients with positive reverse pivot shift test and prone external rotation test at least 3 weeks after their trauma. We excluded the patients with varus malalignment of the knee and concomitant anterior cruciate ligament (ACL) rupture. Biceps tenodesis (Clancy method) was performed. We did not reconstruct posterior cruciate ligament (PCL) if its insufficiency was diagnosed in addition to posterolateral rotatory instability. Knee scoring scale of Lysholm was used during and after follow ups. The results were statistically compared using Wilcoxon signed rank test (WSRT), paired samples t-test and friedman test. Data analysis was done using SPSS (version 11.5) and Stata (version 8) computer softwares.

Results: Our series consists of 13 patients (12 male and one female). 31% of the patients had isolated posterolateral injury and 69% of the patients had combined posterolateral and PCL injuries. The patients were between 17 to 45 years old (mean 30.25 years). Follow up was between 4 to 44 months (mean: 31 months). At the end of follow up 85% of patients had negative reverse pivot shift test. Prone external rotation test at 30° of knee flexion was negative in 92% of patients. In 92% of patients giving way was negative and in 77% of patients pain was decreased. Before operation the average Knee scoring scale of Lysholm was 73 and at the end of the follow up it increased to 85 (p value<0.001).

Conclusions: Biceps tenodesis using Clancy method is a safe, effective and reliable method in management of chronic posterolateral rotatory instability of the knee. During surgery careful exploration of the common peroneal nerve is recommended. Although we found this method effective in combined posterolateral and PCL injuries the results are much better in the cases with isolated posterolateral injuries.

Background: Anterior glenohumeral instabilities can be corrected with open and arthroscopic surgery. The purpose of this study was to evaluate retrospectively the surgical outcomes of arthroscopic repair of anterior glenohumeral instabilities with use of suture anchors in a series of patients who were followed for twenty to fifty months.

Methods: The results of arthroscopic Bankart repair with use of suture anchors in 30 patients with traumatic recurrent anterior instability of the shoulder were evaluated. At the time of follow-up (mean of thirty-three months), the patients were assessed with two outcome measurement tools (the Rowe score, the Constant score). The recurrence rate, range of motion, and risk factors for postoperative recurrence were evaluated.

Results: According to the Rowe scale, 12 patients (40%) had an excellent score 13 (43%), a good score 4 (13%), a fair score and 1 (4%), a poor score. The mean ROWE score was 81.8 and the mean CONSTANT score was 85.5. Overall, the rate of postoperative recurrence of instability was 10% (two dislocations, one subluxation). The mean delay to recurrence was 20 months. Loss of external rotation in regard to uninvolved extremity was less than 10 degrees in 30% and more than 10 degrees in 10% of patients. The average number of anchors used was 3.2 which follow-up radiographs showed all of them in the osseous glenoid without pullout. In preoperative studies, shoulder 3D CT scan was not performed routinely. Radiographic signs of degenerative changes were noted in one shoulder.

Conclusion: Arthroscopic capsulolabral repair with use of suture anchors can provide satisfactory outcomes in terms of recurrence rate, activity, and range of motion.

Background: McGill pain questionnaire is the most useful standard tools for assessing pain. McGill pain questionnaire contains 78-word descriptive of the 20 subclasses form-ing in three main sensory, affective and evaluative domains. Due to cultural differences, the questionnaire has been translated into several languages. This study aimed to transl-ate MPQ into Persian language and assess its reliability, validity and acceptability in patients with cancer.
Methods: The study performed in Medical Oncology Department of Cancer Institute in Imam Khomeini Hospital in the Spring 2012. After translation of MPQ by two experts fluent in English, Persian version was returned to English. Then that backward transla-tion was compared with the original questionnaire and words that did not match were reviewed.  Patients with different types of cancer who suffering from chronic pain were admitted in our study. They did not receive any kind of pain killer drugs during the pre-vious 24 hours. There was no restriction of age, sex, education, type of cancer or treat-ment modality. The reliability and validity of Persian-McGill pain questionnaire after interviewing patients was assessed by test–retest reliability and internal consistency (Cronbach’s alpha).
Results: In total, 84 patients were interviewed and 30 patients who were available after 24 hour with the same condition recomplete the questionnaire. Cronbach’alpha of each domain was in 0.622-0.743 and total Crobach’s alpha (n=84) was 0.85. Evaluative aspect has only one subgroup and because of this, it is not have Crobach’s alpha. The stability coefficient (n=30) in all areas (sensory, emotional, and other domains) were 0.812-0.964. Stability coefficient among the 20 Persian McGill Pain Questionnaire (PMPQ) subclasses showed significant and reliable relationships over time for all groups.
Conclusion: This study is the first study that assessed psychometric properties and use-fulness of the MPQ in Iranian patients with cancer, showed that it is a potentially useful measure with a high validity and reliability standards.